States that are administering their own state-run Insurance Exchange will set their own ECP requirements for their state. However, the ACA definition of ECPs as providers eligible to participate in the 340B program applies.

Safe Harbor

In order to ensure that QHPs meet network adequacy standards (including ECP inclusion), CMS will use a tiered approach, referred to as the “safe harbor standard.”

To meet this requirement, at least 20% of available ECPs in the plan’s service area must be included in the provider network, including at least one ECP per type (includes Ryan White Program provider), per county where.

Plans that cannot meet this standard must submit to CCIIO a narrative justification describing how they will ensure access to care for low-income, medically underserved ,and vulnerable populations, and also how they intend to increase ECP participation in their network in future years.

The list included some information on HRSA grantees, including Ryan White Providers, but did not incorporate many providers, and included inaccurate contact information for others.

Many insurers are still using this list to determine networks of care. HIV providers may want to contact CCIIO Ryan White providers at EssentialCommunityProviders@cms.hhs.gov if they are not on the list or if their contact information is incorrect.